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   Government of Canada

Statement from the PHAC (Public Health Agency of Canada

"When traveling outside of Canada, you may be at risk for a number of vaccine preventable illnesses.  You should consult a Health Care Provider or visit a Travel Health Specialist preferably 6 weeks before you travel.  You may need additional vaccines depending on your age, planned travel activities and local conditions.  Preventing disease through vaccination is a lifelong process."

 

TRAVEL HEALTH SPECIALIST (THS)

Travel Health Specialists have in-depth knowledge of immunizations, thanks associated with specific destinations, and the implications of traveling with underlying conditions.  Therefore, a comprehensive consultation with a Travel Health Specialist is indicated for ALL travellers and is particularly important for those with complicated health history, special thanks (such as travelling at high altitudes, working in refugee camps, or exotic or complicated itineraries.

Twitter:      @globetravelhlth  

Linkedin:    Hans B. Epp

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Table 2-02. Vaccines to update or consider during Pre-Travel Consultations

VACCINE

TRAVEL-RELATED OCCURRENCES AND RECOMMENDATIONS

Routine Vaccines (Vaccination considerations should be based on ACIP guidelines.)

Haemophilus influenzaetype b

No report of travel-related infection, although organism is ubiquitous.

Hepatitis B

Recommended for travelers visiting countries where HBsAg prevalence is ≥2%. Vaccination may be considered for all international travelers, regardless of destination, depending upon the traveler’s behavioral risk and potential for exposure as determined by the provider and traveler.

Human papillomavirus (HPV)

No report of travel-acquired infection; however, sexual activity during travel may lead to HPV and other sexually transmitted infections.

Influenza

Year-round transmission may occur in tropical areas. Outbreaks have occurred on cruise ships, and 2009 influenza A (H1N1) illustrated the rapidity of spread via travel. Novel influenza viruses such as avian influenza H5N1 and H7N9 can be transmitted to travelers visiting areas with circulation of these viruses.

Measles, mumps, rubella

Infections are common in countries and communities that do not immunize children routinely, including Europe. Outbreaks have occurred in the United States as a result of infection in returning travelers.

Meningococcal

Outbreaks occur regularly in sub-Saharan Africa in the “meningitis belt” during the dry season, generally December through June, although transmission may occur at other times for those with close contact with local populations. Outbreaks have occurred with Hajj pilgrimage, and the Kingdom of Saudi Arabia requires the quadrivalent vaccine for pilgrims.

Pneumococcal

Organism is ubiquitous and causal relationship to travel is difficult to establish.

Polio

Unimmunized or underimmunized travelers can become infected with either wild poliovirus or vaccine-derived poliovirus. Because the international spread of wild poliovirus in 2014 was declared a Public Health Emergency of International Concern under the International Health Regulations, temporary recommendations for polio vaccination are in place for countries with wild poliovirus circulation for their residents, long-term visitors, and international travelers.

Rotavirus

Common in developing countries, although not a common cause of travelers’ diarrhea in adults. The vaccine is only recommended in young children.

Tetanus, diphtheria, pertussis

Rare cases of diphtheria have been attributed to travel. Pertussis has occurred in travelers, recently in adults whose immunity has waned.

Varicella

Infections are common in countries that do not immunize children routinely, as in most developing countries. Naturally occurring disease tends to affect adults.

Zoster

Travel (a form of stress) may trigger varicella zoster reactivation, but causal relationship is difficult to establish.

Travel Vaccines

Cholera

Cases in travelers have occurred recently in association with travel to Haiti.

Hepatitis A

Prevalence of hepatitis A virus infection may vary among regions within a country. Serologic testing may be considered in travelers from highly endemic countries since they may be immune. Some travel health providers advise people traveling outside the United States to consider hepatitis A vaccination regardless of their country of destination.

Japanese encephalitis

Rare cases have occurred, estimated at <1 case/1 million travelers to endemic countries. However, the severe neurologic sequelae and high fatality rate warrant detailed review of trip plans to assess the level of risk.

Rabies

Rabies preexposure immunization simplifies postexposure immunoprophylaxis, as adequately screened immunoglobulin may be difficult to obtain in many destinations.

Tickborne encephalitis [vaccine not available in the United States]

Cases have been identified in travelers with an estimated risk of 1/10,000 person-months in travelers. Endemic areas are expanding in Europe.

Typhoid

UK surveillance found the highest risk to be travel to India (6 cases/100,000 visits), Pakistan (9 cases/100,000 visits), and Bangladesh (21 cases/100,000 visits), although risk is substantial in many destinations.

Yellow fever

Risk occurs mainly in defined areas of sub-Saharan Africa and the Amazonian regions of South America. Some countries require proof of vaccination for entry. For travelers visiting multiple countries, order of travel may make a difference in the requirements.

Abbreviation: HBsAg, hepatitis B surface antigen.